Organization
PREMIER VASCULAR CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AJITH KADAKOL MD (PHYSICIAN / OWNER)
(586) 573-8030
Entity
Organization
Contact information
Practice address
1701 SOUTH BLVD E STE B75, ROCHESTER HILLS, MI 48307-6122
(248) 243-3935
(248) 284-7530
Mailing address
3205 LEGACY CT, W BLOOMFIELD, MI 48323-3634
(583) 573-8030
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
4301093222
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891742128
INDV NPI
MI
01
—
4301093222
LICENSE
MI
01
—
5315045037
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
03/07/2012
Last updated
03/07/2023
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